DURHAM — Photographs in Charlie Montoyo’s office give an indication of the issues that regularly confront the Durham Bulls manager.

It’s not coping with slumping batters or erratic pitchers. It’s not assessing base running or bullpens.

In this case, it’s the snapshots of Alex Montoyo hooked up to all sorts of machines as an infant and a toddler.

And now, yet another challenging time has arrived for the Montoyo family, with 5-year-old Alex facing his fourth open-heart surgery Monday in Los Angeles.

Charlie Montoyo, 48, has taken a leave of absence from the Bulls to be with his family.

“The worst part about it is knowing why he’s leaving,” Bulls pitcher Chris Archer said. “It stinks that he’s leaving, but the worst part is why he’s leaving.

“He and his son are going to be in our thoughts throughout the next week or so. Open-heart surgery for someone so young.”

Medical concerns have existed for Alex Montoyo since his birth. His father has been away from the team at times as the young boy’s medical concerns have overridden any game in the International League. That included a successful surgery in 2009, with the manager returning to work and greeted by hugs from players.

Alex Montoyo suffers from Ebstein’s anomaly, a congenital heart defect meaning one of the valves fails to work properly.

Yet there have been good days, and the youngster has been a regular the past couple of summers in the Bulls clubhouse, a child visiting his father after games.

“Alex was around, running around the clubhouse,” catcher Craig Albernaz said. “Fist-bumping people. … He has been part of the Rays family and Bulls family since before he could walk.”

Durham players knew of their manager’s impending time off for weeks, told by members of the coaching staff. Charlie Montoyo tends not to bring it up, avoiding drawing attention to his family’s plight and the medical crises that have faced the youngest of his two sons.

“He’s a staple here,” Albernaz said of the manager. “He keeps everyone loose. Everyone knew coming in what’s going on. It’s going to be very strange.”

For the Bulls, it’s unusual without Charlie Montoyo around. He’s in his seventh season as the team’s manager and his 17th season overall as a minor-league manager, all within the Tampa Bay Rays organization.

“In the back of your head, knowing he isn’t here for the reason that he isn’t here (is the hardest part). For myself, having a child, it makes it that much tougher to swallow. Things like this shouldn’t happen to children.”

Charlie Montoyo managed the Bulls to a 6-1 record across the opening week of the season before departing. His son was scheduled for a catheter insertion Friday in preparation for this week’s surgery.

Gimenez said he hopes to get something together for the family after operation.

“He’s not on an island by himself,” Gimenez said. “How many times can you be kicked before you fall down? He’s been through it (previously), but it doesn’t make it any easier.”

Hitting coach Dave Myers is serving as acting manager. Charlie Montoyo said he’s appreciative of how the parent Tampa Bay Rays have allowed him the flexibility to be away from the team during these occasions.

This time, Montoyo left lineup cards for two games, but that’s the extent of his involvement.

“If everything goes well for me, I’ll look at the stats and game reports the guys send me,” he said. “If everything goes right …

“There’s so much down time, just waiting. … I’m sure Monday I’m not going to be checking anything — I’ll be in chapel.”

Dan DeMent, a coach with the organization’s short-season Hudson Valley Renegades in the New York-Penn League, will be with the Durham team for the duration of Montoyo’s absence. Other roving coaches in the Tampa Bay organization also will assist.

Guyer, who has played for Montoyo in parts of three seasons, said the veteran makeup of the Durham team allows the Bulls to go about business without hitches. Yet he’s aware of the implications that relate to the duration of the manager’s absence.

“We hope it’s not that long,” he said.

Montoyo’s earliest possible return to the Bulls will be for the April 25 game.

“I told him, ‘We’ll be thinking about you here. Don’t worry about anything here. We’ll hold it down for you,’ ” Gimenez said.